Director Medicare Rac Audit Jobs in Rye, NY (NOW HIRING)

Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state’s most vulnerable and underserved residents.

Founded in 1999, we’ve grown from a single primary care office into a network of 50+ locations offering urgent care, primary care and specialty services, from women’s health to endocrinology and psychiatry. We also provide nursing home support, care management, and in-home care through our Essen House Calls program. Guided by a Population Health model, our team of 500+ providers deliver care in-person, at home, or via telehealth, ensuring patients get the support they need when and where they need it.

We’re looking for talented, motivated individuals to join our growing team. Whether you’re a medical provider, administrator, or operations professional, there’s a career here for you. Join us in making a real difference in the health of our community.

Essen Care Management is seeking a Director of Finance and Operations with deep experience in care management programs to lead our revenue cycle, billing, compliance, and operational infrastructure. This role is responsible for ensuring accurate and timely Medicaid and Medicare reimbursement, safeguarding compliance with New York State Department of Health (NYSDOH) and federal regulations and partnering with clinical leadership to align billing workflows with care delivery. The director will play a central role in protecting revenue, scaling operations, and supporting our mission to coordinate high-quality care for the members and communities we serve.

Revenue Cycle & Billing Operations

• Oversee end-to-end revenue cycle operations for care management services, including eligibility verification, claims submission, payment posting, and reconciliation.
• Supervise billing staff and external billing vendors; set productivity standards, performance metrics, and quality benchmarks.
• Ensure timely and accurate claim submission through NYS eMedNY, MAPP HHTS, and Managed Care Organization (MCO) portals.

Compliance & Auditing

• Maintain compliance with NYSDOH Health Home guidelines, including Health Home Plus (HH+) criteria, community-based mental health assessments, and CMA/MCO contractual requirements.
• Lead internal billing audits, prepare for external audits, and implement corrective action plans as needed.
• Stay current on Medicaid, Medicare, and state regulatory changes; translate updates into operational policy.

Denial & A/R Management

• Track and report on key performance indicators including Days in A/R, denial rates, clean claim rates, and net collection rate.
• Lead the appeals process for denied or underpaid claims and identify root causes to reduce future denials.
• Build dashboards and regular reporting for executive leadership and the board.

Financial Management

• Partner with the CFO and finance team on budgeting, forecasting, and cash flow management.
• Oversee accounts payable, accounts receivable, and month-end close activities related to program operations.
• Analyze program-level financial performance and recommend strategies to improve margins and reimbursement.

Operations & Cross-Functional Leadership

• Partner with Clinical Directors, Care Management Agencies (CMAs), and MCOs to optimize clinical documentation, member enrollment, and billing workflows.
• Manage relationships with EHR and billing system vendors; lead system optimization and implementation projects.
• Develop and document standard operating procedures across finance and operations functions.
• Hire, mentor, and develop a high-performing team.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Business, Accounting, Finance, or related field.
• 5–7+ years of progressive experience in healthcare billing or revenue cycle management.
• 2–3+ years in a direct supervisory or leadership role.
• Direct experience with Health Home and/or Care Management billing in New York State.
• Working knowledge of NYS eMedNY, MAPP HHTS, Medicaid Managed Care, and HCBS billing requirements.
• Proficiency with EHR and billing systems (e.g., Foothold AWARDS, Netsmart, eClinicalWorks, or similar), CPT/HCPCS coding, and Medicaid tracking portals.
• Strong analytical skills and fluency with Excel and reporting tools.
• Demonstrated ability to lead cross-functional projects and manage external partners.

Preferred Qualifications

• Master's degree (MHA, MBA, MPA, or related).
• Experience with behavioral health, HARP, or HCBS programs.
• Familiarity with value-based payment arrangements and per-member-per-month (PMPM) reimbursement.
• Experience scaling operations at a mid-sized nonprofit or community-based organization.

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.